HomeMy WebLinkAboutMortgage_Hurt (6) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Couni n ear
,•:•tillili FOR DEDUCTION FROM ASSESSED VALUATION
-sr„�._ State Form 43709(RU/6pg)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: • • I
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To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought un •
2) Mobile/Manufactured Homes not accessed as Real Property:Must file during the twelve(12)months
before March 31 of each year the deduction is sought - ecorder
See reverse ' e for additional instructions and qualifications. GIBS 0 - - ± I a
Ap or 1ract b -r-.-- -.' :. on reverse side /
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.• r .�'-" / a �/L.- / Oc_ _;'4. /�� - A. Record number Page n •.
Assessed value of real Property as of Mortgage/Contract indebtedness unpaid as of Mortgage/ ebtedness unpaid as of Is the applicant the sole
March 1,arms year March 1,current year date of ap q legal or equitade owner?
goo 0 Yes 0 No
If no,what is his/her exact share of interest? If owned with someone than spouse,indicate with whom
If name on record is afferent than that of applicant,indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller
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Address of mortgagee or contract seller(number end scree state,and ZIP code)
Name of assignee or other owner or balder of mortgage �f_A/�s p e.• �1/?
Address of assignee(number and sheet,city,state,and ZIP code) �V/t 7� (/�/{C/.%
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Does applicant own property in any other If yes,what county? • What Taxing District? Ras this deduction been quested on property
county in Indiana? ❑ Yes ❑ No - .___� re
for current year? -
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COUNTY AUDITOR Drawer NO E0/ .3..
Deduction approved in the amount of: //--y/.�p
20 20 20 20 Card NO. 4.3(11
Signature of County Auditor County -
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I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
/ Sigre'Irwne )� Date(month,day,year)
Ix- Fplll resident add of a t(number and street dim slate,and ZIP code) �7 [�
Uo ' r Sinclair lair Sf. ! 0 + Q/ nrf �/✓ � /ea /
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authwired person (number and sheet,city,state,and ZIP code) •